Zhou F, Diao HR, Zhang XX, Jin Y. Fluid management after hepatectomy: Pursuing precision recovery through balance. World J Gastrointest Surg 2026; 18(10): 119633 [DOI: 10.4240/wjgs.v18.i10.119633]
Corresponding Author of This Article
Yun Jin, MD, Associate Chief Physician, Department of Hepatic-Biliary-Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou 310009, Zhejiang Province, China. jinyunzeyy@zju.edu.cn
Research Domain of This Article
Surgery
Article-Type of This Article
review-article
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Oct 27, 2026; 18(10): 119633 Published online Oct 27, 2026. doi: 10.4240/wjgs.v18.i10.119633
Fluid management after hepatectomy: Pursuing precision recovery through balance
Feng Zhou, Hao-Ran Diao, Xiao-Xiao Zhang, Yun Jin
Feng Zhou, Department of Hepatopancreatobiliary Surgery, The Second People’s Hospital of Quzhou, Quzhou 324000, Zhejiang Province, China
Hao-Ran Diao, Xiao-Xiao Zhang, Yun Jin, Department of Hepatic-Biliary-Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
Co-first authors: Feng Zhou and Hao-Ran Diao.
Author contributions: Jin Y designed and reviewed the manuscript; Zhang XX created the figure; Zhou F and Diao HR wrote the paper, and they contributed equally to this manuscript and are co-first authors. All authors read and approved the manuscript.
AI contribution statement: We used the web version of DeepSeek and the web version of Yuanbao to polish the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Yun Jin, MD, Associate Chief Physician, Department of Hepatic-Biliary-Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou 310009, Zhejiang Province, China. jinyunzeyy@zju.edu.cn
Received: February 2, 2026 Revised: February 23, 2026 Accepted: May 25, 2026 Published online: October 27, 2026 Processing time: 253 Days and 4.9 Hours
Abstract
Post-hepatectomy fluid management represents a critical determinant of patient outcomes, poised at the intersection of maintaining adequate organ perfusion and mitigating complications from fluid overload. The unique postoperative pathophysiology - characterized by systemic inflammation, transient hepatic insufficiency, and fluid redistribution - creates a clinical dilemma where both hypovolemia and hypervolemia carry significant risks. Contemporary practice has evolved from empirical, one-size-fits-all regimens toward a phased, goal-directed, and individualized strategy underpinned by dynamic hemodynamic monitoring. In the early postoperative phase (0-24 hours), a restrictive approach utilizing balanced crystalloids (initial target of 30 mL/kg/day to 35 mL/kg/day) is recommended. During the stable phase (> 24 hours), the focus shifts to achieving a negative fluid balance via diuretics, provided organ perfusion is secured. For special situations - including patients with cirrhosis, postoperative hemorrhage, or acute kidney injury - rigorous, real-time assessment of fluid responsiveness using dynamic parameters such as stroke volume variation and lactate trends is paramount. This opinion review synthesizes current evidence and controversies to present a modern, enhanced recovery after surgery-aligned framework for post-hepatectomy fluid management, arguing that meticulous, data-driven regulation is fundamental to reducing complications, promoting liver regeneration, and optimizing recovery.
Core Tip: Post-hepatectomy fluid management is critical to postoperative recovery, with the core goal of balancing adequate organ perfusion and avoidance of fluid overload. A phased, goal-directed strategy is recommended: A restrictive 0-24 hours postoperative phase with restrictive fluid resuscitation using balanced crystalloids, followed by a stable phase (> 24 hours) targeting negative fluid balance via diuretics while preserving effective systemic perfusion. Guided by dynamic monitoring of key parameters, this enhanced recovery after surgery-aligned individualized approach prevents complications like pulmonary edema and intra-abdominal hypertension, promotes liver regeneration, and optimizes key clinical outcomes for patients undergoing hepatectomy.
